Oncologic Emergencies Dr Karenza Alexis

Oncologic Emergencies

• Dr Karenza Alexis

Spinal Cord Compression

• 1-5% of patients with systemic cancer

• MUST BE TREATED IMMEDIATELY

• Can lead to irreversible paralysis or loss of bowel and bladder function

• Tumor or collapsed fragments in the epidural space

Spinal Cord Compression

• Most Common sites

• Thoracic spine (70%)
• Lumbrosacral (20%)
• Cervical (10%)

• Most common malignancies

• Lung
• Breast
• Unknown primary
• Prostate
• Renal
• Multiple myeloma
• Lymphoma

Spinal Cord Compression

• Symptoms and Signs

• Localized pain to the spine
• Exacerbated by movement, recumbency, coughing, sneezing, straining
• May appear weeks to months before neurological symptoms
• Radicular pain
• Weakness +/- sensory loss
• Autonomic dysfunction
• Urinary retention, constipation

Spinal Cord Compression

• Evaluation- complete neurologic and physical exam that includes:

• Gentle percussion of spinal column
• Passive neck flexion
• Straight Leg raise
• Motor and sensory exam, Reflexes
• Pinprick testing toe to head- sensory level
• Is there a “sensory level”
• RECTAL exam